Changes in international normalized ratio (INR) and Model for Endstage Liver Disease (MELD) based on selection of clinical laboratory

J. F. Trotter, J. Olson, J. Lefkowitz, A. D. Smith, R. Arjal, J. Kenison

Research output: Contribution to journalArticlepeer-review

94 Scopus citations

Abstract

Priority for liver transplantation is based on the Model for Endstage Liver Disease (MELD) score, a mathematical function which includes international normalized ratio (INR). We present an analysis to determine the lab-to-lab variation in INR at 14 clinical laboratories across the United States. We performed a survey to identify representative clinical laboratories across the United States, where INR was measured in the determination of MELD score. Five 'standard' samples for INR were formulated and were sent to the 14 clinical laboratories to determine variation in INR and MELD score. Among the 14 clinical laboratories, the range in INR for the five samples was: sample 1 (1.2-2.0), sample 2 (1.4-2.5), sample 3 (1.7-3.4), sample 4 (1.9-3.7) and sample 5 (2.4-5.1). The range in calculated MELD score was: sample 1 (8-14), sample 2 (10-17), sample 3 (12-20), sample 4 (14-21) and sample 5 (16-25). The selection of the clinical laboratory used to determine INR may result in substantial changes in MELD score independent of severity-of-illness. These data suggest that further review of interlaboratory variation in MELD should be undertaken because of the potential impact on prioritization for liver transplantation.

Original languageEnglish (US)
Pages (from-to)1624-1628
Number of pages5
JournalAmerican Journal of Transplantation
Volume7
Issue number6
DOIs
StatePublished - Jun 2007

Keywords

  • Liver allocation
  • Liver transplantation MELD

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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